This program project brings together a group of investigators and cooperating clinicians who have a major interest in quantifying and developing new procedures and patterns of care to minimize the effect of cancer treatment on the functional status of head and neck cancer patients as soon after treatment as possible. The 5 projects included in this grant reflect the philosophy that rehabilitation begins with prevention and detection and extends to pretreatment intervention and to the selection of treatment techniques. All of the 5 projects are proposed for 5 years. Project 1 compares 3 methods of swallow assessment in the evaluation of deglutition in head and neck cancer patients: modified barium swallow, biomechanical analysis, and manofluorography. We are interested in whether quantified techniques provide any additional information over observation of swallow. Project 2 examines functional effects of tracheostomy on swallow in head and neck cancer patients who are about to be decannulated. Project 3 examines the biomechanical effects of head and neck surgical procedures on swallowing function and on the patient's reactions to various bolus types and swallow maneuvers. A biomechanical analysis of swallow should enable us to define the changes in muscle pull created by head and neck surgical procedures and develop more effective swallow interventions and surgical reconstructions. Project 4 quantifies the effects of reconstruction on speech and swallowing function in 15 groups of oral cancer patients. This project proposes to continue the work begun in the first 5 years of the current project. Project 5 continues our previous development of a Performance Status Scale for head and neck cancer patients by examining functional changes in laryngeal cancer patients and developing functional profiles for these patients. We also propose to compare performance scores with objective data in a group of head and neck patients. the long term objective of this Program Project is to establish and maintain a cooperative interdisciplinary, inter-institutional team of investigators who will continue to develop and implement cancer rehabilitation protocols with carefully quantified outcomes to address key issues in the functional status of head and neck cancer patients.